This patient guide addresses severe traumatic or terrifying events, which are characterized by a sense of horror, helplessness, serious injury or the threat of serious injury or death. They include those that occur to individuals, such as violent crimes, and those that occur to large numbers of people, such as natural disasters. Although other events, such as the loss of a job, divorce or a terminal illness can also be traumatic, they are not addressed in this patient guide.
It is normal for people who witness or experience extreme events to have feelings of depression or anxiety afterward. However, sometimes individuals react to these events with feelings of intense fear, helplessness or horror and experience symptoms of grief for a long period of time. In such cases, they may be experiencing post-traumatic stress disorder (PTSD) or major depression, which can interfere with a person’s ability to function.
It is generally recommended that patients consult with a mental health professional such as a psychologist or psychiatrist following traumatic events. These mental health practitioners can help educate patients about normal responses to traumatic stress as well as help them find constructive ways of dealing with the emotional impact of such events.
In addition, there are many things individuals can do to promote emotional well-being and restore a sense of control after experiencing trauma.
Tips for coping with traumatic events include:
- Accept personal feelings. It is normal to experience feelings of anger, sadness, fear and grief following traumatic events.
- Give oneself time to heal.
- Incorporate a healthy lifestyle and avoid alcohol and cigarette smoking.
- Turn to relatives, friends and others for emotional support.
- Join a support group for victims of traumatic events.
- Seek medical attention. Depending on the source of the trauma the person may require immediate emergency medical treatment. Psychological treatment may also be necessary.
About traumatic events
Traumatic or terrifying events are characterized by a sense of horror, helplessness, serious injury or the threat of serious injury or death. Such events cause psychiatric trauma (also called emotional harm).
Following a severe traumatic event, a person retains emotional memories that become embedded deep within the brain. Experts believe that the risk of psychiatric trauma is related to the how close a person is to the traumatic event. For example, a person who is injured during a robbery, or whose life was directly threatened, would have a higher risk of trauma than a person who witnessed the event without actually being threatened.
However, people can become traumatized even if they were not directly involved in the event. For instance, studies following the September 11, 2001 terrorist attacks on the United States found that many people watching the events on television experienced symptoms of psychiatric trauma and post-traumatic stress disorder(PTSD).
Psychiatric trauma often occurs on a mass scale following an event like September 11 and natural disasters such as hurricanes, floods and earthquakes. There are also numerous examples of traumatic events that affect individuals. They include physical or sexual abuse, violent crimes, and serious accidents such as an automobile crash. The sudden and unexpected death of a loved one can also be traumatic.
It is a normal reaction for people who experience or witness such events to become depressed or anxious for a period of time afterward. Common physical responses following traumatic events include nausea, dizziness and changes in appetite or sleep pattern. These are called stress reactions and they may resolve within a few weeks.
However, sometimes individuals react to these events with feelings of intense fear, anxiety, helplessness or horror and experience symptoms of grief for a prolonged period of time. They may also continually relive the experience and find that emotional turmoil interferes with daily tasks and functioning. When this occurs, it is called post-traumatic stress disorder (PTSD). PTSD can affect an individual’s ability to function, and it can develop months or years after the initial trauma. The closer a person is to the trauma (e.g., assault), the greater the risk of developing a severe and lasting reaction.
Although some people recover within three months without treatment, it is generally recommended that patients consult with a mental health professional, such as a psychologist or psychiatrist following traumatic events. These mental health experts can help educate patients about normal responses to traumatic stress as well as help them find constructive ways to deal with the emotional impact of such events.
Tips for coping with traumatic events
There are many things individuals can do to promote emotional well-being and restore a sense of control after experiencing a traumatic event, such as sexual abuse, combat or the death of a loved one.
Coping tips that people who have endured traumatic events may find helpful include:
- Accepting personal feelings. It is normal to experience feelings of anger, sadness, fear and grief following traumatic events. It is important to take time to express those feelings and not keep them to oneself. Crying, writing them down in a journal or confiding in a friend or relative can help provide relief.
- Giving oneself time to heal. Following a traumatic event, emotional healing can take time. Therefore, it is important to be patient with changes in one’s emotional state and not rush back into everyday activities. In addition, most mental health experts recommend not withdrawing from daily life for an extended period of time because doing so may put individuals at risk for developing or worsening of depression.
- Avoiding major life decisions and taking time to resolve day-to-day conflicts. If possible, put off making major life changes, such as switching careers or moving to a new home, immediately following a traumatic event. These activities can be very stressful. Also, taking time to resolve daily conflicts will ensure that these do not add to one’s stress level.
- Avoiding staying away from situations, people or places that remind one of a traumatic event. Doing so is not aneffective way of coping because by avoiding these events one can let fear control one’s life. In addition, gradually exposing oneself to potentially traumatic stimuli can encourage the development of protective coping skills.
- Incorporating a healthy lifestyle. This includes eating a nutritious, well-balanced diet, getting plenty of rest and relaxation, and engaging in exercise as recommended by a physician. This also includes dealing with traumatic stress in unhealthy ways, such as by overeating, drinking too much alcohol, smoking cigarettes or abusing drugs.
- Turning to relatives, friends and others for support. By talking with loved ones about a traumatic event, one can relieve stress and realize that others may have shared similar experiences and feelings.
- Participating in leisure and recreational activities, such as playing with pets and going to the movies with friends. Engaging in activities that are fun and entertaining can help relieve tension and improve mood.
- Joining a support group for victims of traumatic events. These groups provide emotional support and practical coping skills and strategies for victims of traumatic events. They can also be especially helpful for individuals with limited personal support systems.
- Volunteering in the community. Joining relief efforts after mass tragedies such as hurricanes or terrorist attacks can make one feel useful, involved and like a valuable member of the community. Also, volunteering in youth programs, at hospitals and other ongoing community programs can help one regain a feeling of connection and importance.
- Consulting a mental health professional if symptoms (e.g., anxiety, depression, insomnia) interfere with daily functioning and/or persist longer than a month. This is very important because even if individuals follow the abovementioned tips for coping with traumatic events, they may still be at risk of develping post-traumatic stress disorder (PTSD) or experiencing a worsening of any pre-existing mental illnesses (e.g., major depression).
Helping a loved one cope with traumatic events
There are various ways to help loved ones cope with the emotional consequences of traumatic events. It is especially important to let them know that they are not alone in their grief.
Other tips for helping loved ones cope with trauma include:
- Spending time with them and letting them know that they are loved and supported. However, respecting their need to be alone sometimes is also important.
- Letting them know that it is okay to feel upset, sad, scared or however else they may be feeling after a tragedy occurs.
- Encouraging them to express their feelings and thoughts. Avoiding being judgmental when they open up about their experiences and feelings.
- Not making false assurances or speculations. Providing only information that one knows is factual, such as information regarding the severity of an illness.
- Encouraging them to return to daily activities and routines at their own pace.
- Encouraging them to get involved in a support group for trauma survivors.
- Reassuring them that the traumatic event is not their fault.
- Recognizing if they need medical attention. This is very important because sometimes trauma victims may not be able to take the necessary steps to secure medical and/or psychological help.
Helping a child cope with traumatic events
Not unlike adults, children who experience a traumatic event often react in many different ways. Reactions to trauma may occur immediately after a traumatic event or days and even weeks later. Fear of the event reoccurring and loss of trust in adults are common responses in many children and adolescents following any kind of trauma.
Because it can affect their sense of security, younger children may even revert to earlier behaviors such as bedwetting, crying, whimpering, trembling, thumb-sucking, fear of darkness, excessive clinging to parents and throwing temper tantrums.
Children ages 6 to 11 may withdraw from friends and usual activities (e.g., refusal to attend school), compete for more attention from parents, become aggressive, engage in disruptive behavior and find it hard to concentrate. Anxiety, depression, feelings of guilt or emotional numbness, and sleep problems are also common. In addition, children may complain of stomachaches and other ailments that do not have a medical basis.
The responses of older children and adolescents (ages 12 to 17) may be similar to those of adults, including flashbacks, nightmares, depression, emotional numbness, avoidance of reminders of the event and anti-social behavior. They may withdraw from family and friends, experience academic problems, contemplate suicide and/or experiment with alcohol and drugs. Physical complaints, feelings of guilt and revenge fantasies may also occur. At this time it is important to help them deal with their anxiety and grief by offering them consolation, love, support and reassurance.
Recent research suggests that children with above-average intelligence may be less likely to experience traumatic events during childhood and adolescents and less likely to develop post-traumatic stress disorder should such events occur.
Sometimes adults may be too affected by their own emotions following a traumatic event that they may not know initially how to respond to their children’s questions and concerns. Nonetheless, parents or other caregivers should discuss the event or situation openly – without dwelling on frightening details or allowing the subject to dominate family or classroom time indefinitely – with children and try to answer all questions to the best of their ability.
A traumatic event should be discussed in a language that can be understood by children, depending on their age or stage of development. Vague or inaccurate explanations or avoidance of the subject will not protect children and adolescents from trauma. Rather, children may experience feelings of anxiety, confusion, mistrust and unresolved issues later in adulthood.
Following any kind of trauma, children of all ages should be encouraged to express their thoughts and feelings. This can be done through conversation, drawing or painting. Finding ways to help others impacted by a traumatic event like a catastrophic hurricane, such as by organizing a fund raiser or other type of volunteer activity with children, can also be therapeutic as well as rewarding for all involved.
Other tips for helping children cope with traumatic events include:
- Avoiding being judgmental when they open up about their experiences and feelings in addition to reassuring them that the traumatic event is not their fault.
- Not being afraid to admit that one cannot answer all their questions.
- Reassuring children that there are no bad emotions and that a wide range of feelings is normal following a traumatic event.
- Providing ongoing opportunities for children to talk about the event because they will probably have more questions over time.
- Allowing children to open up about their feelings in general, even if these are unrelated to the current situation. This can enhance family communication and send children a strong message: that they are important and cared for.
- Establishing a family emergency plan in the event of a future crisis. This can be very reassuring for both children and adults.
Caring adults should also be alert and realize if children are experiencing symptoms of worsening stress related to their trauma – especially if prolonged – such as depression, inability to sleep or eat, fear of being alone, reverting to infantile behavior (e.g., thumb-sucking), withdrawal from friends and daily activities, difficulty in school and suicidal ideation. In such cases, a child and adolescent psychiatrist or other mental health professional can help children effectively cope with trauma.
Resources available for coping with trauma
It can be extremely useful for individuals who have been affected by a severe traumatic event to become informed about trauma as well as the emotional and behavioral responses that often accompany it. Doing so can help people realize that their feelings and problems are often shared by survivors of trauma. Individuals can find information on trauma and post-traumatic stress disorder (PTSD) on the Internet and in various books on such topics available at libraries or book stores.
A variety of local health and social services exist that can provide timely assistance and support for victims of trauma. These services typically educate individuals about normal responses to traumatic stress as well as positive ways to deal with such events including coping tips that may help prevent PTSD. Health care professionals, such as physicians, nurses, social workers or psychologists may be able to provide coping tips and/or referrals for such resources. Counseling or mental health centers are another helpful option because they provide treatment for psychological trauma (e.g., PTSD) that victims of tragic events can be at risk for.National organizations such as the American Psychiatric Association (1-888-357-7924), American Psychological Association (1-800-964-2000), U.S. National Organizations for Victims Assistance (1-800-879-6682) and the U.S. National Center for Children Exposed to Violence (1-877-496-2238) also can provide reliable information and coping strategies for dealing with such events.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding coping with severe traumatic events:
- It’s been a month since I witnessed a traumatic event. When should I expect to feel better?
- I’m unable to sleep well at night. Should I take medication to help me sleep?
- I was the victim of an attack several weeks ago. Since then, I feel I cannot trust anyone and I frequently imagine that my attacker is stalking me. Do you consider my reactions normal?
- Do most people have the same feelings I do?
- Do you know of community centers that offer recreational activities and other coping strategies for dealing with trauma?
- Since witnessing a car accident a week ago, my child has been withdrawn and appears depressed. Is this normal, and if not, what’s my first step to helping my child?
- Since we survived a natural disaster, my child has begun wetting the bed again, even though he/she has been toilet trained for over a year. Should I be concerned?
- How can I encourage a family member who is in denial to seek psychological help?
- Can you recommend a support group for people in my situation?
- I’ve found that drinking alcohol or taking recreational substances helps relax me and keeps me from thinking about my trauma. Am I at risk of developing a drinking or addiction problem from this habit?